Two studies in Africa find circumcising adult men can cut HIV risk by half

LAURAN NEERGAARD - AP Medical Writer

WASHINGTON - Circumcising adult men may reduce by half theirrisk of getting the AIDS virus through heterosexual intercourse,the U.S. government announced Wednesday, as it shut down twostudies in Africa testing the link.

The National Institutes of Health closed the studies in Kenya
and Uganda early, when safety monitors took a look at initial
results this week and spotted the protection. The studies'
uncircumcised men are being offered the chance to undergo the
procedure.

The link between male circumcision and HIV prevention was noted
as long ago as the late 1980s. The first major clinical trial, of
3,000 men in South Africa, found last year that circumcision cut
the HIV risk by 60 percent.

Still, many AIDS specialists had been awaiting the NIH's results
as a final confirmation.

"Male circumcision can lower both an individual's risk of
infection, and hopefully the rate of HIV spread through the
community," said AIDS expert Dr. Anthony Fauci, director of the
NIH's National Institute of Allergy and Infectious Diseases.

But it's not perfect protection, Fauci stressed. Men who become
circumcised must not quit using condoms nor take other risks - and
circumcision offers no protection from HIV acquired through anal
sex or injection drug use, he noted.

"It's not a magic bullet, but a potentially important
intervention," agreed Dr. Kevin De Cock of the World Health
Organization.

Male circumcision is common at birth in the United States. But
in sub-Saharan Africa, home to more than half of the world's almost
40 million HIV-infected people, there are large swaths of
populations where male circumcision is rare.

The WHO plans an international meeting early next year to
discuss the studies' results and how to translate them into
policies that promote safe male circumcision - done by trained
health workers with sterile equipment - while teaching men that it
won't make them invulnerable.

If male circumcision were widely adopted, officials predicted
that could help to avert tens of thousands of HIV infections in
coming years; Fauci cited one model from South Africa that
suggested possibly up to 2 million infections could be averted over
a decade.

"This is tremendous news, and it could help millions of men
while in turn reducing the risk faced by millions of women," said
Paul Zeitz of the Global AIDS Alliance.

Why would male circumcision play a role? Cells in the foreskin
of the penis are particularly susceptible to the HIV virus, Fauci
explained. Also, the foreskin is more fragile than the tougher skin
surrounding it, providing a surface that the virus could penetrate
more easily.

Researchers enrolled 2,784 HIV-negative men in Kisumu, Kenya,
and 4,996 HIV-negative men in Rakai, Uganda, into the studies. Some
were circumcised; others were just monitored.

Over two years, 22 of the circumcised Kenyans became infected
with HIV compared with 47 uncircumcised men, a 53 percent
reduction. In Uganda, 22 circumcised men became infected vs. 43 of
the uncircumcised, a 48 percent reduction.

The researchers are offering all of the studies' uncircumcised
men the chance to undergo the procedure, and 80 percent of the
uncircumcised Ugandans already have agreed, said lead researcher
Ronald Gray of Johns Hopkins University.

Side effects were rare, including some mostly mild infections
that were easily treated. The rate of side effects was comparable
to those seen in circumcised U.S. infants, said Robert Bailey of
the University of Illinois at Chicago, who led the Kenyan
trial.